452-5 COMPUTATION OF BENEFITS

452-5 COMPUTATION OF BENEFITS

452-5 A. REGULAR APA BENEFIT PAYMENTS

The amount of assistance provided for any month is determined by comparing an individual's or couple's total monthly countable income calculated according to manual section 452-4 with the appropriate APA need/payment standard described in manual section 452-1 and Addendum 1 .

Note : DPA must calculate the countable income rather than using the amount calculated by SSA .

452-5 B. INTERIM ASSISTANCE BENEFIT PAYMENTS

1. Regular IA benefit payments.

Except for institutionalized individuals, IA payments are set by state regulation at $280 per month per individual, as long as their other countable income, after rounding, is equal to or less than the applicable APA need standard.

If both members of a couple are eligible for Interim Assistance, they each receive $280. In couple cases where only one spouse is eligible for Interim Assistance, $280 is paid only to that individual. If one member of a couple is eligible for Interim Assistance and the other member is eligible for regular APA benefits, each member of the couple is budgeted as an individual until Interim Assistance ends.

2. IA benefit payments to institutionalized individuals

Individuals who reside in a Medicaid facility such as a nursing home may not receive the regular $280 Interim Assistance monthly payment. However, depending on their other countable income, they may receive an Interim Assistance payment which, combined with any other countable income, is equal to the regular $200 APA personal needs maximum payment standard.

452-5 C. PERSONAL NEEDS BENEFIT PAYMENTS

This section applies to any person who resides in a Medicaid facility such as a nursing home continuously for an entire calendar month, except for individuals who remain eligible for full APA benefits because of temporary institutionalization provisions. (Refer to section 470-2 for the policy on continued benefits for temporarily institutionalized individuals.)

An individual who is eligible for SSI may receive a monthly payment for incidental personal needs from SSI of up to $30. APA will provide an additional payment to provide a total amount of $200 for personal needs.

An individual who is ineligible for SSI , but whose countable income is less than the APA personal needs standard, may receive an APA payment. However, the payment cannot exceed the amount that would be paid to a similarly situated SSI recipient. See section 452-5A(1) above for more information about this payment limit policy.

An individual whose countable income exceeds $200 is not eligible for an APA payment but may be eligible for Medicaid.

Note: Medicaid eligibility policies pertaining to institutionalized individuals may differ from APA policies. See ADLTC 514 for policy on Medicaid eligibility for institutionalized individuals.

452-5 D. ASSISTED LIVING HOME PAYMENTS

Individuals residing in an assisted living home for a full calendar month have their APA eligibility and payment calculated using the assisted living home need/maximum payment standards.

Example: (based on 2026 payment standards) A married couple who are both eligible for APA reside in an assisted living home. The couple's combined income from Social Security benefits is $1,511 per month. After the $20 income exclusion is allowed, the couple's net countable income is $1,491. Use the APA need/maximum payment standard for an eligible couple and subtract the couple's net countable income. $1,691 APA maximum payment standard for a couple, both eligible, in an assisted living home (H2C) - $1,491 Net countable income = $200 APA payment ($100 to each spouse)